Perspectives of French General Practitioners Regarding their Role in Detecting Alcohol Consumption in Pregnant Women and Identifying Individuals with Fetal Alcohol Spectrum Disorders: A Qualitative Study

Abstract Background: Foetal Alcohol Spectrum Disorder (FASD) is the leading cause of non-genetic mental disability and social maladjustment in children. International guidelines recommend zero alcohol during pregnancy. Reunion is the most concerned from all the French regions with an estimated Foetal Alcohol Spectrum (FAS) prevalence of 1.2‰ births. General practitioners (GPs) are at the forefront of identifying patients with FASD. Objective: To understand how GPs identify FASD. Methods: Qualitative study with a grounded theory approach, through semi-structured face-to-face interviews with GPs. The interviews were conducted with the aim of reaching the theoretical saturation. These were transcribed into verbatim and then analysed by four researchers to ensure the triangulation of the data. Results: The GPs reported obstacles to identify FASD: challenges in addressing taboos and paradoxical injunctions in society, the influence of limited knowledge and experience, non-specific and highly varying symptoms, ambiguous classification and method of diagnosis involving the mobilization of a multidisciplinary team and lengthy consultations. Conversely, they felt competent to identify neurodevelopmental disorders of all causes but were concerned about the long waiting period to access to specialized care. As per GPs' perspective, it is crucial to prioritize the promotion and training aimed at enhancing the identification and coordination of care pathways for children diagnosed with neurodevelopmental disorders, such FASD.